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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
HEATHER REPPETO (EXECUTIVE DIRECTOR)
(503) 535-3860
Entity
Organization

Contact information

Practice address
1226 SW 12TH AVE, PORTLAND, OR 97205-2029
(503) 535-3898
Mailing address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 535-3800

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Enumeration date
11/03/2016
Last updated
10/08/2025
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